What are the discharge instructions for a patient with an injury due to a fall?

From the Guidelines

Discharge instructions for a patient with an injury due to a fall should prioritize fall prevention, pain management, and monitoring for complications, with a focus on early mobilization and multidisciplinary care, as recommended by the most recent and highest quality study 1. When managing a patient with an injury due to a fall, it is essential to consider the following key points:

• Pre-operative management should include consideration of planning for discharge from hospital, as well as measures to prevent secondary falls 1.
• Early mobilisation is a key part of the management of patients with hip fractures, and should be prioritized in discharge instructions 1.
• A multifaceted programme for fall prevention should consist of a core assessment and recommendations adapted to individual risk, including medical assessment, home safety assessment, and exercise training 1.
• Discharge instructions should include education on fall prevention, such as removing tripping hazards, improving lighting, and installing grab bars in bathrooms, as well as monitoring for warning signs requiring immediate medical attention, such as increasing pain, swelling, or numbness/tingling.
• Patients should be instructed to follow up with their primary care provider within 1-2 weeks, or sooner if symptoms worsen, and to begin gentle movement once acute pain subsides to prevent stiffness, but avoid activities that cause pain.
• The use of analgesics, such as acetaminophen or ibuprofen, should be considered for pain management, unless contraindicated by other medical conditions.
• Compression bandages and elevation of the injured area can help reduce swelling and pain, but should be used with caution to avoid numbness or tingling.
• Telephone follow-up or enrollment in a rehabilitation program can serve to reinforce in-hospital instruction, provide reassurance, and answer the patient’s questions, and can help monitor progress in meeting risk factor modification goals 1.

From the Research

Discharge Instructions for Patients with Injuries due to Falls

Discharge instructions for patients with injuries due to falls are crucial to prevent further injuries and ensure a smooth recovery. The following points highlight key considerations:

• Pain Management: According to 2, acetaminophen can be considered the mainstay for pain relief in patients recovering from extremity fracture surgical procedures, as it is not inferior to acetaminophen and tramadol.
• Fall Prevention: Studies such as 3 and 4 emphasize the importance of engaging patients and families in understanding fall prevention interventions and factors contributing to falls during hospitalization and at discharge.
• Post-Discharge Falls: Research like 5 and 6 indicates that patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge, highlighting the need for targeted interventions.
• Patient Education: 4 suggests that older patients have low levels of knowledge about appropriate falls prevention strategies, emphasizing the need for healthcare workers to design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.
• Circumstances of Falls: 6 found that older patients who have been recently discharged from hospital and receive assistance with activities of daily living are at high risk of injurious falls indoors, most often in the bedroom, indicating the need for targeted interventions to reduce falls in this population.

Key Considerations for Discharge Instructions

When creating discharge instructions for patients with injuries due to falls, consider the following:

• Provide clear instructions on pain management, including medication and non-pharmacological interventions.
• Educate patients and families on fall prevention strategies, including environmental modifications and behavioral changes.
• Assess the patient's risk of post-discharge falls and provide targeted interventions, such as home safety assessments and exercise programs.
• Ensure patients understand the importance of follow-up appointments and rehabilitation to prevent further injuries and promote recovery.
• Consider the patient's individual needs and circumstances, such as requiring assistance with activities of daily living, when developing discharge instructions.